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Unusual cause of failed medical termination of pregnancy
*For correspondence: drppallavee@gmail.com
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This article was originally published by Wolters Kluwer - Medknow and was migrated to Scientific Scholar after the change of Publisher.
A 22 yr old female† with miscarriage at 24 wk was admitted on July 23, 2019 to the department of Obstetrics and Gynaecology, Mahatma Gandhi Medical College and Research Institute, Puducherry, India. She underwent hysterotomy due to a failed medical termination of pregnancy (MTP) and was diagnosed to have pregnancy in the non-communicating rudimentary horn of a unicornuate uterus (Fig. 1). A dead macerated foetus of 340 g and placenta of 100 g were delivered. Decision to excise the pregnant non-communicating horn was deferred as prior consent was not taken. Five weeks later, the patient reported abdominal pain and fever. Ultrasonography revealed fluid collection with internal echoes in the rudimentary horn suggestive of haematometra/pyometra. Magnetic resonance imaging pelvis showed a unicornuate uterus with haematometra in the non-communicating left horn (Fig. 2). The patient was started on prophylactic antibiotics and counselled for surgery. Excision of the non-communicating horn was carried out. On cut section of the left horn, necrotic tissue with pus was noted (Fig. 3). Histopathological testing revealed coagulative necrosis with chronic inflammatory infiltrate in the attached fallopian tube. The patient was discharged six days after surgery and resumed her normal menstrual cycles. Thus, a suspicion of possible uterine anomalies should always be kept in mind in cases of failed MTP. In such cases, a meticulous first-trimester scan should be carried out to reveal the true clinical picture.
- Hysterotomy specimen showing the right horn (arrow with black border and white fill) and left non-communicating horn (black arrow) of the unicornuate uterus.
- Magnetic resonance imaging pelvis showing a unicornuate uterus with haematometra in the non-communicating left horn (black arrow) and a separate right horn (arrow with black border and white fill).
- Pus (arrow) in the excised horn.
Conflicts of Interest: None.
